Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Wednesday, October 23, 2013

Obamacare 2016: Happy Yet?

From Bradley Allen, MD in the opinion section of the Wall Street Journal this morning:

"The forecast shortage of doctors has become a real problem. It started in 2014 when the ACA cut $716 billion from Medicare to accommodate 30 million newly "insured" people through an expansion of Medicaid. More important, the predicted shortage of 42,000 primary-care physicians and that of specialists (such as heart surgeons) was vastly underestimated. It didn't take into account the ACA's effect on doctors retiring early, refusing new patients or going into concierge medicine. These estimates also ignored the millions of immigrants who would be seeking a physician after having been granted legal status.It is surprising that the doctor shortage was not better anticipated: After all, when Massachusetts mandated health insurance in 2006, the wait to see a physician in some specialties increased considerably, the shortage of primary-care physicians escalated and more doctors stopped accepting new patients. In 2013, the Massachusetts Medical Society noted waiting times from 50 days to 128 days in some areas for new patients to see an internist, for instance.But doctor shortages are only the beginning.Even before the ACA cut $716 billion from its budget, Medicare only reimbursed hospitals and doctors for 70%-85% of their costs. Once this cut further reduced reimbursements, and the ACA added stacks of paperwork, more doctors refused to accept Medicare: It just didn't cover expenses.Then there is the ACA's Medicare (government) board that dictates and rations care, and the board has begun to cut reimbursements. Some physicians now refuse even to take patients over 50 years old, not wanting to be burdened with them when they reach Medicare age. Seniors aren't happy."Medicaid in 2016 has similar problems. A third of physicians refused to accept new Medicaid patients in 2013, and with Medicaid's expansion and government cuts, the numbers of doctors who don't take Medicaid skyrocketed. The uninsured poor now have insurance, but they can't find a doctor, so essentially the ACA was of no help.The loss of private practice is another big problem. Because of regulations and other government disincentives to self employment, doctors began working for hospitals in the early 2000s, leaving less than half in private practice by 2013. The ACA rapidly accelerated this trend, so that now very few private practices remain."

Anon 12:08, I don't know that anyone is blaming O care for all the things that have happened. I am not an MD, but I have worked in the healthcare field in various capacities, beginning as what was called a ward clerk in hospitals in the 1970's. I have also been a hospital patient several times in my life. In my opinion, it is government intervention in the markets and collusion with corporations through lobbyists that is to blame for much of the problems in the healthcare industry. I watched as government gradually implemented laws/regulations which incrementally took (and continues to take) away and/or ties a physician's hands when it comes to deciding the best course of treatment for their patients. The NOT so affordable healthcare law gives more control and power to people who do not even know the patient; this law does not even address or remedy the very reasons why people cannot afford medical treatment. This law has created another giant, extremely expensive, self-feeding bureaucratic maze, that only ADDS to the rising costs of insurance and care. I know a few Doctors who are opting out because they are sick of it, and I don't blame them. As a patient, I am tired of some overpaid bureaucrat or insurance company in cahoots with government deciding what kind of care I receive and for how long.Government needs to stay OUT of the markets, period. But they won't, because the entire economic system is built on collusion, so things will get more chaotic and UN-affordable for the average American citizen.

I feel the involvement of multiple layers of non-care giving administrative personnel to hospital organizations has taken the responsibility of how to care for patients away from Allied professionals, and put the evaluations and reimbursements into the hands of regulators and administrators. Physicians have been out maneuvered by lawyers and MBAs. Most everyone has meant well, but we are seeing a confluence of unintended consequences. Many felt taking the power away from physicians could make health costs less, and while physician revenues have been successfully reduced, cost of care has sky rocketed. My theory is that it is because we have such a large middle-man structure full of folks who do nothing to make patients better. They suck up money for parking garages, waterfalls in lobbies, and sensitivity training for volunteers, while patient care suffers and outcomes are not improving. The addition of more government regulations, and the total absence tort reform, competitive across state line insurance competition (the unholy deal made by the insurers and the president), and a real effort to reduce unnecessary costs will continue our health care in a death spiral with the end result a very UK like collapse of health care in the US.

Dear Anon #1,You posted a list of questions here. Why not google/bing for answers instead of putting the work on strangers? Would you even read the answers if we posted them?

I'm one of those self-employed people who had insurance cancelled--- the alternatives are NOT affordable. So I would be forced to accept a subsidy-- another word for welfare paiod by my fellow tax-slaves.We effectively have death panels- if you can't afford the oncologist team who were keeping you alive, you are forced to get care from the in-network folks.

I've told my children to consider moving to another country to have a better future-- as my father once encouraged his kids to move away from the East Coast. I'm close to shutting down my business and leaving too.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.